Anthem Blue Cross California
Anthem Blue Cross is one of the leading health insurance providers in the United States. Anthem has been with Covered California since the beginning of the Affordable Care Act (ACA), also known as Obamacare, in 2014. Covered California Anthem Blue Cross plans have been the biggest sellers on the Exchange in past years, and though some changes have recently taken place, Anthem Blue Cross still has well over 100,000 members in the parts of California it covers.
Recent Changes in California
As of January 2018, because of the current instability of the individual healthcare market, Anthem no longer offers individual health insurance plans in many parts of California. Californians in these three regions can still purchase Anthem Blue Cross individual insurance policies:
- Region 1: Northern Counties — includes Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne and Yuba counties
- Region 7: Santa Clara County
- Region 10: Central Valley — includes Mariposa, Merced, San Joaquin, Stanislaus and Tulare counties
While Anthem Blue Cross did previously cover many people living in areas that are no longer covered, not everyone in these uncovered regions are affected by the change. The change applies to most types of individual health policies, which leaves some other types unaffected. Let’s take a look at which types of plans are still offered outside of Regions 1, 7 and 10:
- Grandfathered Plans: Members across California who enrolled in an Anthem Blue Cross Plan before March 23, 2010, when the ACA took effect and continued to keep that grandfathered plan will not be affected by the change.
- Medi-Cal or Medicare Supplement Plans: Members with these plans will continue to keep their coverage.
- Group Health Insurance Plans: Group health insurance plans are completely unaffected by changes made to the individual policy market.
- Dental Insurance: Anthem dental insurance will continue to be offered to all Californians, regardless of region.
- Vision Insurance: Anthem will also continue to sell and support vision insurance to Californians across the state.
Another recent change is that Anthem no longer offers PPO (preferred provider organizations) or HMO (health maintenance organizations) individual health plans, so all of their plans are now EPO (exclusive provider organizations). An EPO plan falls somewhere in between an HMO and PPO plan. Let’s take a quick look at these three terms to better understand what an EPO plan is and how it compares to other types of plans:
- HMO: With an HMO plan, you must only use providers in your network, you have to identify a primary care physician (PCP) in the network, and you must get a referral from your doctor to see a specialist.
- PPO: A PPO plan allows for more flexibility in choosing providers, doesn’t require you to choose a PCP and won’t require you to get a referral to see a specialist. A PPO plan also costs you more month-to-month, and out-of-network providers will still be more expensive to use than in-network ones.
- EPO: An EPO plan, like an HMO plan, makes it is more important that you stay within your network, or else you will end up spending more money out-of-pocket on out-of-network providers. However, like a PPO plan, an EPO plan does not require you to identify a PCP and often doesn’t require referrals for specialists.
Anthem Blue Cross Plans
Californians within Anthem Blue Cross’s covered regions can choose from a range of plans designed to fit your budget and give you the level of coverage you desire. Let’s take a look at the different plans available, starting with the plans that only certain individuals qualify for, based on factors like age and income.
- Medicare Advantage: Medicare Advantage plans in California allow you to bring the coverage offered by Medicare Parts A, B and D together into one plan. Purchasing a Medicare Advantage plan tends to make more financial sense than buying a Medicare Supplement plan plus Part D.
- Medicare Supplement Insurance Plans: California Medicare Supplement plans cover costs that you might otherwise have to pay if you had Original Medicare alone. These costs include copays, coinsurance and deductibles. For even more complete coverage, you can purchase dental and vision insurance from Anthem Blue Cross.
- Medicare Prescription Drug Coverage: If you take prescription drugs, especially expensive ones, you may want to take advantage of Anthem’s Medicare prescription drug coverage plans. You can pay for prescription drug coverage as a Medicare Part D plan in California, or you can buy it to complement a Medicare Supplement plan.
- Medicaid Plans: Medicaid is a public health insurance program for a variety of people, including those with low incomes, those with disabilities and children in foster care, among others. Anthem Blue Cross is contracted with the Department of Health Care Services to provide Medicaid coverage, called Medi-Cal in California, to qualifying individuals.
- Minimum Coverage: The minimum coverage plan costs less than the cheapest standard plan and is available to people under age 30 and those who qualify for a hardship exemption. This plan covers preventative care and a limited number of office visits to your in-network primary care provider for free.
Now, let’s look at the standard plans. As mentioned previously, these plans are all EPO policies. Typical of Obamacare-era insurance policies, the plans are labeled with different metals to indicate the levels of price-points and coverage:
- Bronze: Bronze is a good basic plan for individuals who are in good health, especially those who are young and don’t have any dependents. This plan has low monthly payments and covers check-ups and preventative care. The downside is that any unexpected additional medical costs will require you to pay more out of pocket.
- Silver: While this plan still has fairly low monthly payments, the Silver plan is a step up from Bronze in that it covers more medical treatment. Preventative care is free, with no copay or deductible from providers in the network. What could cost you out-of-pocket is a hospital visit or appointment with a specialist. If you don’t anticipate you’ll need special medical attention outside of routine care, Silver is a great option to consider.
- Gold: Gold is the next level up from Silver. This plan covers more, so it won’t cost you as much if you need to see a doctor or specialist, and if you experience an illness or need to visit the hospital, your monthly payments and out-of-pocket costs will be minimal. Your deductible will also be lower.
- Platinum: The Platinum plan is the highest tier, meaning it has higher premiums but also provides the highest level of coverage. Routine visits to the doctor, preventive care and emergencies are all covered with little to no deductible. This plan will cost you more month-to-month but could save you or your family from large out-of-pocket expenses that may arise.
When you’re shopping for health insurance, you may find you run into some unfamiliar terms and have questions about aspects of health insurance in general or about specific providers or plans. Let’s take a look at some of the questions that commonly come up in regards to health insurance:
- How Are My Costs Determined?
The monthly premium you pay for insurance depends on several factors. First, the type of plan you choose may cost more or less depending on the amount of coverage it provides. If you pay more each month, that likely means you won’t have to pay as much out-of-pocket when you incur medical costs. Aside from the plan itself, other factors that affect your premium rate include your age, geographical location, whether you use tobacco products and whether your plan also covers a spouse or any dependents. Neither your medical history nor your current state of health will affect your premium rates.
- What Is a Deductible?
When looking at different insurance plans, it’s important to understand several terms that have to do with the way you and your insurance company share the responsibility of paying for health care services. Deductible is one of these terms. A deductible is the dollar amount you agree to pay for medical services before your insurance kicks in. The lower the deductible, the less you’ll have to pay in the event of an illness, injury or other medical situation. Lower deductibles tend to mean higher monthly premiums, and higher deductibles mean lower monthly payments. Note that preventative care and routine check-ups are often covered by your insurance even when you haven’t met your deductible.
- What Is Coinsurance?
Coinsurance is another term related to the way you and your insurer divide the cost of health care between you. Coinsurance is the percentage you pay once you have met your deductible and your insurance kicks in. Lower coinsurance means your insurance is covering more of the cost. Again, higher monthly premiums tend to be associated with lower coinsurance, and lower monthly premiums are associated with higher coinsurance.
- What Is a Copayment?
A copayment, commonly called shortened to “copay,” is a set dollar amount you pay for certain health services after you have met your deductible. For example, you might pay an amount like $20 when you go for a checkup with your doctor. This amount can vary depending on the service. For example, your copay for a visit to a specialist may be different from your copay for a lab test. As with your deductible and coinsurance, higher monthly payments tend to mean your copay will be lower, and lower monthly payments tend to mean your copay will be higher.
- What Is an Out-Of-Pocket Limit?
Your out-of-pocket limit is the highest dollar amount your plan could allow you to pay in a given calendar year. If you end up having a lot of medical costs due to a serious illness or surgeries, for instance, you could potentially meet this limit. Once you do, your insurance will pay for all your medical expenses up to the maximum allowed amount through the rest of the year at absolutely no cost to you.
- What Is the Difference Between In-Network and Out-Of-Network Providers?
Your insurance company contracts with certain doctors, hospitals, labs and more to provide services to its members at a rate determined by the insurance company and the provider. These providers are in your network. That means if you go to an in-network doctor, your insurance company will help pay whatever amount your plan says it will. Out-of-network providers don’t have an arrangement with your insurance company, so they can end up being quite a bit more expensive to use. Fortunately, Anthem has a broad network of providers that you can choose from. Want to know which providers are in your network? Try searching online using the Find a Doctor tool.
- What Do I Do If I’m Traveling out of State and Need to See a Doctor?
Seeing local doctors in your network is great. But what if you’re traveling out of state and need medical attention? Anthem offers two great features that could help in this situation.
- The BlueCard: Anthem offers a BlueCard for individual and family plans that allows you to use some health care services in other states, as long as you’re in a Blue Plan service area. The program spans the country and more than 200 participating countries and territories across the world. When you take advantage of this program while traveling, it doesn’t require any extra paperwork and doesn’t cost you any more out-of-pocket than using your local in-network providers.
- Telehealth: Telehealth is an online program offered through LiveHealth that allows you to have live conversations with a doctor or specialist using your computer or mobile device. If you want to speak to a doctor in English, you can call any time of day and any day of the week. Spanish-speaking doctors are available from 7 a.m. to 11 p.m. No matter where you are, as long as you have access to the internet, you can have a face-to-face conversation with a doctor who can even prescribe medications for you in most states outside of California. This feature is included for Anthem Blue Cross members — you just pay a small copay each time you use it.
- Does Insurance Cover Prescription Medications?
Health insurance can help you pay for many prescription medications. Insurers have a list of prescription drugs that they cover, called a formulary. As with other health care services, your level of coverage for prescriptions will differ depending on your plan. You can find out which prescription drugs Anthem Blue Cross covers by looking through the various drug lists online. You can also conveniently search for a certain drug to see if it’s included in the formulary.
Shop for Anthem Blue Cross
If you’re interested in enrolling in an Anthem Blue Cross California health insurance policy, you can get a quote online by providing some basic information. This tool will also help you find out if you qualify for a government subsidy or Cost Sharing Reduction on your Anthem EPO plan. For Anthem Blue Cross California quoting, plan selection and enrollment support by phone, call 1-877-752-4737.
Find Doctors and Providers
Use the Find a Doctor tool online to locate doctors and providers who accept your California health insurance coverage through Anthem Blue Cross. You can search as a member or as a guest. If you search as an Anthem Blue Cross member, you will need to enter your username and password or your ID. The advantage to this is that the website will be able to tailor the search criteria so it only shows you physicians, specialists and providers who take your specific Anthem plan.
Member Services and Login Information
If you are an Anthem Blue Cross California member, you can access your personal portal online by logging in. For technical assistance with your online account, call 1-866-755-2680. Tech support is available Monday – Friday from 5 a.m. to 5 p.m. PST. For assistance with Anthem Blue Cross dental plans, call 1-888-209-7852. For premium payments and other support services, call 1-866-249-4844. To contact Anthem Blue Cross of California by mail, use one of the following addresses:
- Regarding Membership
Anthem Blue Cross
PO Box 9051
Oxnard CA 93031
- Checks for premium payments
Anthem Blue Cross
PO Box 54010
Los Angeles CA 90054
- Claims Address
Anthem Blue Cross
PO Box 60007
Los Angeles CA 90060
Health for California Can Help You
Finding the right health insurance plan for your family can be complicated and confusing. Let Health for California help you find the perfect plan. Our agents are well-versed in a variety of plans from Anthem Blue Cross California and other companies. We can get you a quote quickly and guide you through the application process. We get paid by the insurance companies, so working with us won’t cost you anything extra and will make the process a lot easier. Contact us today to find your perfect plan.
by John Hansen
What’s an EPO? That was the big question for many consumers during the 2017 Open Enrollment Period in California. It made consumers uneasy, and it caused many to switch from Anthem Blue Cross Covered California to Blue Shield Covered California.
Yes, there is a difference. Anthem stopped offering out-of-network coverage. And, for many Californian’s who want choice, they felt they would be limited by this.
Whether you go with Anthem or Blue Shield, it most often makes the most sense to stay in network. Your out-of-pocket costs remain so much lower when you stay in-network.
Anthem was losing money on their out-of-network coverage offered by their PPO’s so they made a gutsy move to switch all their individual and family plans over to EPO’s and stop offering out-of-network coverage. But they may have made a mistake.
Blue Shield of California was facing the same challenges with their PPO products, but they chose to keep offering out-of-network coverage. This was a huge ri...
By John Hansen
As a reminder, effective January 1, 2017, some consumers who have Anthem Blue Cross Covered California will have a plan change from a Preferred Provider Organization (PPO) to an Exclusive Provider Organization (EPO). Covered California consumers who were enrolled in certain Anthem Blue Cross PPO plans in regions 1 through 9 and 15 through 19 in 2016 are impacted by this change.
If you take no action to renew or change plans through Covered California, your coverage will automatically be renewed 30 days after the date on the Covered California renewal notice, into the Anthem Blue Cross EPO plan available in your area. If you want to make a change to your plan for coverage beginning January 1, 2017, a new plan must be selected by December 15, 2016.
PPO plans are the most desirable because they offer out-of-network coverage. However, they tend to be more expensive and sometimes people don’t use the out-of-network coverage enough to make it worthwhile. On a PPO, your out-o...
by John Hansen
Blue Shield of California has Sutter in their network. Anthem does not. Regarding Stanford, Anthem offers coverage through the hospital but not the medical group. Blue Shield has both.
In Santa Barbara, the Cottage Hospital and Sansum networks are with Anthem Blue Cross, but Blue Shield does not have them. Blue Shield has questioned, “Is it worth adding a network when you’d have to increase your rates in that region by 10% to do so?”
Both Anthem Blue Cross and Blue Shield of California offer Obamacare California health plans through Covered California, the state exchange. In the Health Insurance Marketplace in 2016, the top selling medical policies were the Covered California Blue Shield plans. However, in 2014 and 2015, Anthem Blue Cross Covered California plans were #1 sellers on the Covered California Exchange.
With these two health insurance California competitors, their premiums tend to be very comparable. Depending on your region, the cheapest California health p...
by John Hansen
Anthem Blue Cross and Blue Shield of California are leading the way when it comes to transparency regarding the cost of various health care procedures. They are now providing online tools where consumers can look up various health care procedures, see average costs, and view mortality rates. This helps California consumers in two primary ways.
When your doctor or surgeon tells you a procedure is going to cost X amount of dollars, you can respond intelligently. You’ll know whether or not your medical provider is offering you a reasonable price.
In the past, health plan members often took their physician’s word for it, not having any way to know whether or not the price was affordable. Now, consumers can check average costs ahead of time. They can haggle for a better price, or they can vote with their feet and go find someone who will give them an affordable price.
Mortality rates are worth checking. If you have a 15% chance of dying on the operating table, that may make...
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